Frameworks and methodologies configured to enable design and implementation of customised clinical information systems, enable native interoperability between customisable clinical information systems, enable process efficiency management in clinical information systems

ABSTRACT

Described herein are relates to frameworks and methodologies configured to enable design and implementation of customised clinical information systems. One embodiment includes a computer implemented method for providing Clinical Information System (CIS) functionalities, the framework including: providing a plurality of purpose-specific CIS interfaces, wherein each interface is renderable at a given client terminal based on CIS interface design data, wherein the CIS interface design data includes: (i) content pages, wherein each content page is configured to contain one or more page objects; and (ii) logical rules defining navigation and behaviour of content pages; providing access to a common central patient information database; providing a content and process design user interface, thereby to enable a user of a client terminal to define, by way of a graphical Interface, CIS interface design data; and operating a content and process engine.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a U.S. National Phase of International PatentApplication Serial No. PCT/AU2015/000352, entitled “FRAMEWORKS ANDMETHODOLOGIES CONFIGURED TO ENABLE DESIGN AND IMPLEMENTATION OFCUSTOMISED CLINICAL INFORMATION SYSTEMS, ENABLE NATIVE INTEROPERABILITYBETWEEN CUSTOMISABLE CLINICAL INFORMATION SYSTEMS, ENABLE PROCESSEFFICIENCY MANAGEMENT IN CLINICAL INFORMATION SYSTEMS AND/OR ENABLEIMPLEMENTATION OF INDEPENDENT FORMAL ONTOLOGY VALUES IN CUSTOMISEDCLINICAL INFORMATION SYSTEMS,” filed on Jun. 16, 2015. InternationalPatent Application Serial No. PCT/AU2015/000352 claims priority toAustralian Patent Application No. 2014902286, filed on Jun. 16, 2014;and to Australian Patent Application No. 2014902288, filed on Jun. 16,2014; and to Australian Patent Application No. 2014902290, filed on Jun.16, 2014; and to Australian Patent Application No. 2014902294, filed onJun. 16, 2014; and to Australian Patent Application No. 2014902296,filed on Jun. 16, 2014. The entire contents of each of the above-citedapplications are hereby incorporated by reference for all purposes.

FIELD OF THE INVENTION

The present invention relates to frameworks and methodologies configuredto enable design and implementation of customised clinical informationsystems. Some embodiments have been particularly developed for providinga hybrid between best-of-breed architecture and enterprise architecture,thereby to allow a clinical environment to leverage advantagesassociated with each. Some embodiments have been developed to enablenative interoperability between customisable clinical informationsystems. Some embodiments have been developed to enable processefficiency management in clinical information systems. Some embodimentshave been developed to enable implementation of independent formalontology values in customised clinical information systems.

While some embodiments will be described herein with particularreference to that application, it will be appreciated that the inventionis not limited to such a field of use, and is applicable in broadercontexts.

BACKGROUND

Any discussion of the background art throughout the specification shouldin no way be considered as an admission that such art is widely known orforms part of common general knowledge in the field.

The use of Clinical Information Systems (CIS) has become popular incontexts such as managing patient information and workflows. There aretwo broad categories of software that has been used to provide suchsystems:

-   -   Customized tailor made software (also known as “best-of-breed”        software) which is custom developed for a particular        implementation or situation. This is advantageous, in the sense        that there is scope of case-specific tailoring. However, there        are typically high development overheads, and challenges in        integrating with other systems.    -   Enterprise software, which is implemented across a facility.        This also comes with its advantages, particularly by reference        to a broad range of functionalities that are often provided with        relatively expansive software products, however there are        inherent challenges in dealing with specific situations due to        lack of customisation.

Furthermore, both approaches traditionally suffer from deficiencies inthe sense that processes and procedures (and hence businessrequirements) develop and change over time, whilst software updates andmodifications can be slow to keep up thereby to accommodate for suchdevelopments and changes.

SUMMARY OF THE INVENTION

It is an object of the present invention to overcome or ameliorate atleast one of the disadvantages of the prior art, or to provide a usefulalternative.

One embodiment provides a computer implemented method for providingClinical Information System (CIS) functionalities, the frameworkincluding:

providing a plurality of purpose-specific CIS interfaces, wherein eachinterface is renderable at a given client terminal based on CISinterface design data, wherein the CIS interface design data includes:

(i) content pages, wherein each content page is configured to containone or more page objects; and

(ii) logical rules defining navigation and behaviour of content pages;

providing access to a common central patient information database,wherein the plurality of purpose specific CIS interfaces each havedirect read and write access the common central patient informationdatabase;

providing access to a common Patient Administration System (PAS),wherein the plurality of purpose specific CIS interfaces each havedirect native access to functionalities provided the common PAS;

providing a content and process design user interface, thereby to enablea user of a client terminal to define, by way of a graphical Interface,CIS interface design data; and

operating a content and process engine configured to, based uponinteraction between the client terminal and content and process designuser interface, define content and process data for enabling renderingof a plurality of custom CIS user interfaces at distributed clientterminals.

One embodiment provides a computer implemented framework for providingClinical Information System (CIS) functionalities, the frameworkincluding:

a plurality of purpose-specific CIS interfaces, wherein each interfaceis renderable at a given client terminal based on CIS interface designdata, wherein the CIS interface design data includes:

(i) content pages, wherein each content page is configured to containone or more page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

a common central patient information database, wherein the plurality ofpurpose specific CIS interfaces each have direct read and write accessthe common central patient information database.

One embodiment provides a computer implemented framework for providingClinical Information System (CIS) functionalities, the frameworkincluding:

a plurality of purpose-specific CIS interfaces, wherein each interfaceis renderable at a given client terminal based on CIS interface designdata, wherein the CIS interface design data includes:

(i) content pages, wherein each content page is configured to containone or more page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

a common Patient Administration System (PAS), wherein the plurality ofpurpose specific CIS interfaces each have direct native access tofunctionalities provided the common PAS.

One embodiment provides a computer implemented method for providingClinical Information System (CIS) functionalities, the method including:

providing a content and process design user interface, thereby to enablea user of a client terminal to define, by way of a graphical Interface,CIS interface design data, wherein the CIS interface design dataincludes:

(i) content pages, wherein each content page is configured to containone or more customisable page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

operating a content and process engine configured to, based uponinteraction between the client terminal and content and process designuser interface, define content and process data for enabling renderingof a plurality of custom CIS user interfaces at distributed clientterminals.

One embodiment provides a computer implemented method for providingClinical Information System (CIS) functionalities, the method including:enabling a user to generate CIS content data via a graphical contentediting platform; and hosting the generated CIS content data thereby toallow a further user to interact with a CIS rendered based on thegenerated CIS data.

One embodiment provides a computer implemented method for providingClinical Information System (CIS) functionalities, the method including:

providing a content and process design user interface, thereby to enablea user of a client terminal to graphically define CIS interface designdata, wherein the CIS interface design data includes:

(i) content pages, wherein each content page is configured to containone or more customisable page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

maintaining data indicative of a plurality of distinct CIS interfacesdefined via the content and process design user interface;

enabling a user to customise a first customisable page object by:

(a) selecting a second customisable page object; and

(b) setting a rule to use a value associated with a current user inrespect of the second customisation page object.

One embodiment provides a computer implemented framework for providingClinical Information System (CIS) functionalities, the frameworkincluding:

a plurality of purpose-specific CIS interfaces, wherein each interfaceis renderable at a given client terminal based on CIS interface designdata, wherein the CIS interface design data includes:

(i) content pages, wherein each content page is configured to containone or more page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

a monitoring engine configured to collect data representative of userinteraction with each CIS interface, thereby to enable determination ofprocess efficiency.

One embodiment provides a computer implemented method for providingClinical Information System (CIS) functionalities, the method including:

providing a content and process design user interface, thereby to enablea user of a client terminal to define, by way of a graphical Interface,CIS interface design data, wherein the CIS interface design dataincludes:

(i) content pages, wherein each content page is configured to containone or more customisable page objects; and

(ii) logical rules defining navigation and behaviour of content pages;and

wherein the user interface enables a given object to be associated witha formal value defined in an independent formal ontology.

One embodiment provides a computer program product for performing amethod as described herein.

One embodiment provides a non-transitive carrier medium for carryingcomputer executable code that, when executed on a processor, causes theprocessor to perform a method as described herein.

One embodiment provides a system configured for performing a method asdescribed herein.

Reference throughout this specification to “one embodiment”, “someembodiments” or “an embodiment” means that a particular feature,structure or characteristic described in connection with the embodimentis included in at least one embodiment of the present invention. Thus,appearances of the phrases “in one embodiment”, “in some embodiments” or“in an embodiment” in various places throughout this specification arenot necessarily all referring to the same embodiment, but may.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner, as would be apparent to one ofordinary skill in the art from this disclosure, in one or moreembodiments.

As used herein, unless otherwise specified the use of the ordinaladjectives “first”, “second”, “third”, etc., to describe a commonobject, merely indicate that different instances of like objects arebeing referred to, and are not intended to imply that the objects sodescribed must be in a given sequence, either temporally, spatially, inranking, or in any other manner.

In the claims below and the description herein, any one of the termscomprising, comprised of or which comprises is an open term that meansincluding at least the elements/features that follow, but not excludingothers. Thus, the term comprising, when used in the claims, should notbe interpreted as being limitative to the means or elements or stepslisted thereafter. For example, the scope of the expression a devicecomprising A and B should not be limited to devices consisting only ofelements A and B. Any one of the terms including or which includes orthat includes as used herein is also an open term that also meansincluding at least the elements/features that follow the term, but notexcluding others. Thus, including is synonymous with and meanscomprising.

As used herein, the term “exemplary” is used in the sense of providingexamples, as opposed to indicating quality. That is, an “exemplaryembodiment” is an embodiment provided as an example, as opposed tonecessarily being an embodiment of exemplary quality.

BRIEF DESCRIPTION OF THE DRAWINGS

Embodiments of the invention will now be described, by way of exampleonly, with reference to the accompanying drawings in which:

FIG. 1 schematically illustrates a framework according to oneembodiment.

FIG. 2A and FIG. 2B illustrate methods according to various embodiments.

FIG. 3 illustrates an exemplary client-server framework.

FIGS. 4A, 4B, 4C and 4D provide screenshots according to an exemplaryembodiment.

DETAILED DESCRIPTION

Described herein is technology including frameworks and methodologiesconfigured to enable design and implementation of customised clinicalinformation systems (CIS).

Some embodiments have been particularly developed for providing a hybridbetween best-of-breed architecture and enterprise architecture, therebyto allow a clinical environment to leverage advantages associated witheach. Some embodiments have been developed to enable nativeinteroperability between customisable clinical information systems. Someembodiments have been developed to enable process efficiency managementin clinical information systems. Some embodiments have been developed toenable implementation of independent formal ontology values incustomised clinical information systems.

Various exemplary embodiments are discussed below.

General Overview

Embodiments described below relate to the provision of multiple ClinicalInformation System interfaces via a common framework. For example, agiven healthcare facility may have individual CIS relating to the likesof oncology, emergency, radiology, colonoscopies, and so on.

The term “Clinical Information System” (referred to herein, in singularor plural, using the abbreviation CIS) describes a software-basedproduct (i.e. a product that performs one or more computer executablemethods via the execution of computer readable code using one or moreprocessors) which provides functionality relevant to a clinicalenvironment. This is used interchangeably with “CIS interface”. The term“CIS user interface” describes a user interface rendered at a clientterminal thereby to provide functional access to a given CIS. Forexample, a CIS user interface may be rendered in a web browserapplication, which downloads CIS interface design data from a server, orproprietary “parent” software application, which is able to load any oneof multiple available CIS interfaces as functionally executable files.

The term “CIS interface design data” describes data indicative of CISuser interface components (such as pages and objects) and underlyinglogic, which is generated by a user, and enables the rendering of a CISuser interface.

A given CIS typically provides one or more “workflows”. A workflow is aseries of steps that are followed, for example involving data entry,thereby to assist in monitoring and/or management of clinical proceduresand activities. For example, a workflow may be completed via the entryof information into a plurality of electronic forms. As describedherein, these electronic forms are defined on “content pages”. Eachcontent page is configured to contain one or more page objects, such as:

-   -   Information objects (for example text-based data, such as a        question or prompt, image data, video data, and so on).    -   Interactive buttons (for example a “submit” button, “next page”        button, and so on).    -   Data fields, which are configured to contain values. These        values may be user inputted, or automatically determined (for        example as default values, calculated values, or values obtained        from a specified source based on defined logic/rules).

It will be appreciated that this is a very basic selection of exemplarypage objects only, and that a wide range of page objects may be present(for example using page objects known form general web page technology).

A workflow is additionally associated with logical rules definingnavigation and behaviour of content pages. For example these define anorder in which pages are completed (which may vary depending on observedvalues), allowable values for certain data fields, mandatory/optionalstatuses for certain data fields, and so on.

Various embodiments considered below provide a content and processdesign user interface, thereby to enable a user of a client terminal tographically define CIS interface design data. For example, this contentand process design user interface allows a user to create customworkflows. This is achieved by user-generation of content pages andlogical rules. Preferably the content and process design user interfaceprovides a selection of generic customisable page objects (for examplebuttons, data fields, and information objects). A user is enabled toplace these onto a content page (for example using a “drag and drop” orother approach) and customise the objects by setting one or moreparameters. Customisation may be achieved by providing access to, for agiven object, a customisation menu which allows setting of parameters.This setting of parameters additionally allows for defining of logicalrules. This provides a very user-friendly CIS generation tool, allowingfor the creation and modification of workflows without any specialsoftware development and/or coding skills.

Each individual CIS leverages a common overall software infrastructure,for example leveraging a common set of patient management systems anddatabases. In this manner, general overarching CIS functionalities,which are required for all CIS systems (for example patient admission)are centralised and available to be shared. Accordingly, each individualCIS need only be concerned with its specific workflows that are relevantto the particular situation for it is designed. This provides advantagesof “best-of-breed” software, in that each CIS is custom tailored forspecific situations, (optionally be extremely specific in nature),whilst retaining overall infrastructural advantages typically associatedwith enterprise software.

Exemplary Framework

FIG. 1 illustrates a framework according to one embodiment. In overview,this framework provides CIS functionality to a plurality of clientterminals 100, which may be substantially any form of computing devices(for example PCs, notebooks, tablets, smartphones, and so on). Theseclient terminals may access CIS functionalities in two main ways:

-   -   Generation and/or modification of CIS interfaces (such as in the        case of exemplary client terminal 101). As described further        below, this is achieved by way of a content and process design        tool user interface 130. User interface 130 may be provided, for        instance, by way of a browser-based arrangement (user interface        data is rendered via a web browser), or via a proprietary        standalone software application.    -   Rendering of CIS user interfaces (such as in the case of        exemplary client terminal 102), thereby to provide a user with        access to workflows associated with a given CIS. This may be        achieved by way of a browser-based arrangement (whereby CIS        interface design data is rendered via a web browser thereby to        provide a CIS user interface), a “parent” software approach        (whereby CIS interface design data is rendered via a proprietary        software application specially configured to load such data) or        via multiple standalone software applications.

In relation to the latter, FIG. 1 illustrates common systems 110 (suchas patient admission) and custom designed CIS interfaces 120 (forexample discrete CIS interfaces for Emergency, Trauma, Colposcopy, GynaeOncology, Breast Cancer, Multi-Disciplinary Meetings (MDM),Hysteroscopy, Surgical Wards, Oncology Wards, Theatre Management, AlliedHealth, Perioperative Services, Day Infusion, Ambulance, ColorectalCancer, Haemo-Oncology, Lung Cancer, Neuro-Oncology, Sarcoma, Skin &Melanoma, Uro-Oncology, and so on).

Common systems 110 provide each of the custom designed CIS interfaceswith native access to common functionalities, including the likes ofPAS, analytics, and the like. That is, a suite of common functionalitiesrequired by a CIS are inherently natively available for each custom CIS120 as a result of common systems 110.

Common systems 110, custom designed CIS interfaces 120, and userinterface 130 are illustrated as client side components, in the sensethat they provide functionality that is accessed by client devices 100.On the opposed server side there is provided a composite CIS managementsystem 150, which may be defined by a single server, or by multiple(optionally distributed) server and/or other computing components.

System 150 provides back-end support to the various client sidecomponents. For example, common systems engines 151 provide server sidefunctionality relating to patient management and the like, whilstcontent and process engine 152 provide service side functionalityrelevant to user interface 130. Code for enabling execution of customCIS interfaces 120 is maintained in a content and process datarepository 154 (also referred to as a CIS data repository, discussed inmore detail further below).

A patient data repository 153 maintains data associated with each of aplurality of patients. This data includes details defined during patientregistration (for example via a PAS included in common systems 151), anddata defined by the operation of any one or more of CIS interfaces 120.That is, as a CIS interface is used, that may result in new data valuesbeing associated with a patient. Hosting all of this data in a commonpatient database is particularly valuable in the context of intra-CISdata sharing. Aspects of such data sharing are discussed in detailfurther below by reference to native interoperability.

Relational data store 155 is illustrated to graphically represent asingle relational database that includes both patient data 153 andcontent/process data 154.

Data repositories 153-155 may be defined by any number of discretedatabase components, and are illustrated as three separate discretedatabase as an example only.

System 150 also provides external interaction modules 156, which enableinteraction with external systems 170 (such as other softwareapplications, databases, and the like). This may include interaction byway of APIs and/or by predefined interaction protocols, such as HealthLevel 7 (HL7) Standards or the like.

CIS Content Generation and Hosting

As shown in FIG. 1, content and process design user interface 130operates in conjunction with a content and process engine 152. Engine152 is configured to, based upon interaction between a given clientterminal and user interface 130, define content and process data forenabling rendering of a custom CIS user interfaces at any of clientterminals 100. More specifically, interaction with interface 130 causesengine 152 to generate CIS data, this CIS data being indicative ofuser-generated (or user-modified) content pages (and hence also logicalrules defining navigation and behaviour of content pages, with thoseruled being defined by customisation of page objects).

In the present embodiment, CIS data is maintained in a CIS datarepository 154. In a preferred embodiment, this data is defined in XMLformat, for example defined in terms of page types, page objects, andpage object parameters. CIS data (and hence CIS interfaces) are loadedfrom repository 154 and rendered as user interfaces on-demand. In thismanner, each time a CIS interface is accessed by a client terminal 100(or each time a given workflow is accessed), it is loaded from currentCIS data. This allows modifications made to workflows to be made livesubstantially immediately.

An overall process flow according to an embodiment is illustrated inmethod 200 of FIG. 2A. A user generates CIS data (which may includegenerating a new CIS/workflow/page, or modifying an existingCIS/workflow/page) at 201. Then, upon completion of 201, repository 154is updated at 202. Then, at 203, a CIS interface is loaded (for exampleby downloading of code to enable rending of used interface componentsfor one or more pages) by a client based on up-to-date CIS data fromrepository 154.

FIG. 2A also illustrates a looped process 204, which generallyrepresents the updating of available page objects. As context, when auser selects a new page object for inclusion in a page, that is selectedfrom a set of available customisable page objects (defined in repository158). That set is updated on an ongoing basis, for example where a newform of page object requires development to solve a particular problem.

In relation to content generation, user interface 130 allows a user toeither commence generation of an existing CIS interface, or modify anexisting CIS interface (for example by modifying a particular workflow).

When a page (either new or existing) is opened in interface 130, a useris enabled to select an existing object, or add a new object of desiredtype (from the set of available customisable page objects). As noted,page objects may include the likes of

-   -   Information objects (for example text-based data, such as a        question or prompt, image data, video data, and so on).    -   Interactive buttons (for example a “submit” button, “next page”        button, and so on).    -   Data fields, which are configured to contain values. These        values may be user inputted, or automatically determined (for        example as default values, calculated values, or values obtained        from a specified source).

A user selects or adds an object at 211, and opens an object parametersetting interface (for example by double-clicking the object). Theparameter setting interface provides a menu for allowing access to andsetting of object parameters. These may include:

-   -   Visual parameters, such as font, colour, etc. Visual parameters        such as size and position may in some cases be set graphically        outside of the menu using drag/drop and stretch manipulations.    -   For information objects, the information that is to be        displayed.    -   For interactive buttons, the function of the button (for example        “submit”, “next page”, “previous page”, and so on).    -   For data fields, the nature of data to be inputted (for example        whether it is a date, time, value, etc), allowable value ranges,        selectable values (for example if there is a drop-down menu),        default values, pre-populated values, rules (for example whether        a value is mandatory) and so on.    -   Semantic definitions of the fields using an established        terminology, classification or ontology and a value set defining        the range of values the field can be assigned. For example,        these may allow the embedding of a standardised semantic        definition in an object as a property of the object, for example        using data drawn from a known published formal ontology (such as        SNOMED CT). This allows objective categorisation of data based        on independent standards.    -   Tables of data collated from information already stored about        the patient.

FIG. 4A to FIG. 4D provide sample screenshots from an embodiment of userinterface 130, showing various views relevant to customisation of pageobjects and the like.

In some cases logical rules may be defined for a data field, for exampleusing IF, THEN, and ELSE logical operators. For example, in some cases adata field is set to be pre-populated with a value from patient database153. If the data is not available, that may indicate that anotherworkflow needs to be completed, and a rule is set to launch thatworkflow.

As foreshadowed above, in some embodiments the user interface enables agiven object to be associated with a formal value defined in anindependent formal ontology (such as SNOMED CT, or another ontology).Preferably, the user interface provides a search functionality therebyto assist a user in identifying the formal value based on one or moreuser generated object parameter values.

Native Interoperability

As noted, some cases, a data field is customized to be pre-populatedwith a value, for example a value from patient database 153. Morebroadly, various page objects may be configured to reference values inpatient database 153 for a variety of reasons beyond display (forexample to perform calculations, in the context of an “IF” operation,and so on).

Some embodiments implement a functionality referred to as nativeinteroperability, which in essence allows for streamlined data sharingbetween CIS interfaces. In particular, this includes enabling a user tocustomise a first customisable page object by: (i) selecting a secondcustomisable page object; and (ii) setting a rule to use a valueassociated with a current user in respect of the second customisationpage object. For example, in a simple case this involves setting a datafield to display a value that had previously been inputted via a datafield in another CIS interface.

A key point is that the values are not defined by reference to specificdatabase address codes. Rather, values are associated with the CISinterface, page, and page object from which they originate. In thismanner, a user generating page content need not be familiar withdatabase structure. They simply need to know in which workflow a valueof current interest is inputted, and identify the page object via whichit is inputted.

FIG. 2B illustrates an exemplary method 200 for utilising nativeinteroperability. At 211 a user adds a new page object, or selects anexisting page object. A parameter setting interface is opened at 212(for example via a double click). At 213 a user makes a selection torely on a referenced value, then identifies the relevant CIS (214), CISform (and form page, where a given form spans multiple pages) (215) andpage object (216). Referencing parameters are completed at 217.

CIS Content Sharing

In a similar vein to native interoperability, in some embodiments a useris enabled to insert pre-customised page objects that already exist onother pages (for example in other CIS interfaces). In this regard,repository 154 provides a library of customised content that may beleveraged in future content generation thereby to streamline procedures.

Process Efficiency

Some embodiments provide a methodology and mechanisms of ContinuousProcess Improvement (CPI). This is a critical aspect of work in busydepartments. This includes providing “native analytics” on the data inthe integrated architecture. This allows, for example:

-   -   (i) Analysis of work processes to identify the current costs        (for example in the context of time overheads).    -   (ii) Immediate “on-the-spot” changeability to introduce a new        work practice (for example based on an alteration to one or more        CIS user interface pages, or one or more user interface        components provided on a given CIS user interface page).    -   (iii) Analysis of the new work practices to determine if they        did indeed introduce intended/anticipated improvements.    -   (iv) Ability to either continue with new practices, or        alternately revert to old practices vie “on-the-spot”        changeability.

In this manner, embodiments of the overall CIS technology describedherein contain a mechanism for analysing the usability features ofvarious defined operational workflows. This enables “native usabilitymetrics and measurement”; at any time a given staff member is enabled toview and analyse how he/she uses (and/or other users use) a given CIS.For instance, in some cases this includes how often he/she moves (and/orhow often other users move) in a path from screens A to B to C and thetime spent on each screen). One user may spend four times longerflipping between one screen and another than others, but if piece ofdata were to be moved from one screen to another you would speed up theworkflow. The described framework is configured to enable a rapidprimary assessment, quickly and cheaply change a given CIS (e.g. a CISpage or rule), do the reassessment by looking up some automaticallycollected reporting tables and reinstate the old process immediately ifneeds be.

In this regard, one embodiment provides a computer implemented frameworkfor providing Clinical Information System (CIS) functionalities, theframework including: a plurality of purpose-specific CIS interfaces,wherein each interface is renderable at a given client terminal based onCIS interface design data, wherein the CIS interface design dataincludes: (i) content pages, wherein each content page is configured tocontain one or more page objects; and (ii) logical rules definingnavigation and behaviour of content pages; and a monitoring engineconfigured to collect data representative of user interaction with eachCIS interface, thereby to enable determination of process efficiency.The data representative of user interaction preferably includes datarepresenting time taken for each of a plurality of users to complete agiven workflow defined by one or more content pages. The framework ispreferably configured to provide a comparison of data representing timetaken to complete a given workflow, according to a first workflowconfiguration, with representing time taken to complete the sameworkflow according to a second workflow configuration.

Exemplary Client-Server Arrangement

In some embodiments, methods and functionalities considered herein areimplemented by way of a server, as illustrated in FIG. 3. In overview, aweb server 302 provides a web interface 303. This web interface isaccessed by the parties by way of client terminals 304. In overview,users access interface 303 over the Internet by way of client terminals304, which in various embodiments include the likes of personalcomputers, PDAs, cellular telephones, gaming consoles, and otherInternet enabled devices.

Server 303 includes a processor 305 coupled to a memory module 306 and acommunications interface 307, such as an Internet connection, modem,Ethernet port, wireless network card, serial port, or the like. In otherembodiments distributed resources are used. For example, in oneembodiment server 302 includes a plurality of distributed servers havingrespective storage, processing and communications resources. Memorymodule 306 includes software instructions 308, which are executable onprocessor 305.

Server 302 is coupled to a database 310. In further embodiments thedatabase leverages memory module 306.

In some embodiments web interface 303 includes a website. The term“website” should be read broadly to cover substantially any source ofinformation accessible over the Internet or another communicationsnetwork (such as WAN, LAN or WLAN) via a browser application running ona client terminal. In some embodiments, a website is a source ofinformation made available by a server and accessible over the Internetby a web-browser application running on a client terminal. Theweb-browser application downloads code, such as HTML code, from theserver. This code is executable through the web-browser on the clientterminal for providing a graphical and often interactive representationof the website on the client terminal. By way of the web-browserapplication, a user of the client terminal is able to navigate betweenand throughout various web pages provided by the website, and accessvarious functionalities that are provided.

Although some embodiments make use of a website/browser-basedimplementation, in other embodiments proprietary software methods areimplemented as an alternative. For example, in such embodiments clientterminals 304 maintain software instructions for a computer programproduct that essentially provides access to a portal via which framework100 is accessed (for instance via an iPhone app or the like).

In general terms, each terminal 304 includes a processor 311 coupled toa memory module 313 and a communications interface 312, such as aninternet connection, modem, Ethernet port, serial port, or the like.Memory module 313 includes software instructions 314, which areexecutable on processor 311. These software instructions allow terminal304 to execute a software application, such as a proprietary applicationor web browser application and thereby render on-screen a user interfaceand allow communication with server 302. This user interface allows forthe creation, viewing and administration of profiles, access to theinternal communications interface, and various other functionalities.

Discussion of Advantages

Technology described herein provides for multiple individually designedCISs to run from the one server. Each CIS is designed by its ownclinical team but installed to run on a joint server within the oneversion of the technology described herein. Each system has directaccess to data in any other system where permission is provided, so thatthe records of the same patient being served by different clinicalspecialties can be directly accessed. Data fields in the one system canbe set up to read from data input fields in another CIS. This approachremoves the need for setting up message passing methods for exchangingdata between the systems.

The effect is that each system can be developed independently yet thedata they capture can be available to other CISs as and when it isneeded without any other manual intervention.

This approach is particularly suited to research teams who need to buildtheir own systems but also need a window into the records maintained bythe clinical team. Instead of retrieving the paper record or visiting adistant site to view a record on a local computer the data istransported instantly to the research team the moment it is captured atthe source point.

Technology described herein is based on knowledge that ClinicalInformation Systems are dynamic and need to evolve under the influenceof a number of values, such as:

-   -   Evaluation and subsequent revision of work processes;    -   Changes in professional best practice;    -   New requirements introduced by professional judgement;    -   Introduction of research activities;    -   Movement of personnel.

An optimal methodology will facilitate the client's changes as a resultof the above influences. It also acts to ensure that work practices aregiven their true value. This is achieved through evidence gleaned fromthe collection and analysis of appropriate data. Subsequently, theclient's CIS should be changeable so that the appreciated value of newlydevised work practices is implemented into the system as soon as theyare defined. The CIS should then enable the new collection practices tobe readily learnt and absorbed by the workforce. In this way, the CIS isboth the Servant of Change and the Mechanism of Change without being theDirector of Change whilst serving in the supply of value. It is throughthis evolutionary process that progress with successful IT will advancein a constructive and productive manner. It will be seen as positivelyconstructive in creating valued change instead of the negativedestructive wrecking of current good practices with the introduction ofill-suited IT.

A popular idea that by making clinical practices go digital willautomatically bring process enhancements and efficiencies is one of theuntenable assertions about e-Health.

Most current Health IT software electronically mechanises existingprocesses, but due to their inflexibility future evolution of the CIS ismade more, not less, difficult.

Technology described herein, according to some embodiments, avoids theabove traps in a number of ways:

-   -   Its approach to the analysis of the clinical processes allows        for the current healthcare process to be absorbed into the        designed system;    -   The systematic analysis of the current process that goes into        producing a CIS as described herein forces clinicians, and data        and business managers to reflect on current practice and        encourages both innovative and evolutionary reform;    -   The adaptability of the technology described herein, which        enables rapid changes to the design of systems, provides value        in experimenting with different designs to optimise workable        solutions;    -   The native interoperability within the technology described        herein can save clinicians and associate scientists significant        time in data entry, retrieval and review, as well as exporting        better quality data to third parties involved in care and to        external agencies; and,    -   The inherent plasticity of technology described herein allows        the IT to follow modifications in patient care and to facilitate        an audit as well as clinical and translational research.    -   Technology described herein provides systems that are compact        because they use the most advanced configurations of programming        languages and multi-core processors. Modern technology allows        for much more rapid transition to ever improving techniques in        software engineering that better exploits the lower cost        hardware that has come on to the market in the last 5 years.        Larger and older ERP systems cannot move fast enough to exploit        these technologies and therefore cannot bring down their costs        nor deliver products that are so polished and well-tuned to        clinicians needs.

Technology described herein can reproduce the client's current systemand provide a number of other advantages to the current configuration,such as:

-   -   Data Validation—better validation of data as its input ensures        more reliable data analytics.    -   Data Audit—technology described herein provides mechanisms for        recording all activity of accessing screens and recording data,        and so enables an audit of all user activity.    -   Data Extraction—technology described herein has a variety of        tools for increasingly complex data extraction. At the simplest        level, it has the capacity to extract any tabular information as        CSV or XML files by using mechanisms for exporting forms. This        comes as an intrinsic function without any need for programming.    -   Auto-coding of data according to SNOMED CT. Other coding schemes        can be used where needed. This will create significant        efficiencies for the medical record coding as required for        statutory reporting.    -   Data Analytics—data analytics services will enable better        analysis of the existing data. More complex levels of data        analytics are available through the CliniDAL suite in the form        of ad hoc questioning, hypothesis testing, concept based        searching of text fields and predictive modelling.    -   The most advanced level is the development of predictive models        to utilise the full value in any existing minimum dataset in        order to identify the variables that best predict outcomes and        then to apply them for prognostic purposes. This approach has        been used previously for the Society of Plastic Surgeons on        their breast implant database to identify the effectiveness of        their minimum data set for predicting patient outcomes.    -   Automatic loading of data into a registry. technology described        herein is able to be HL7-compliant, so any registry which can        receive HL7 messages can be automatically loaded with the data        from a compatible CIS.    -   Application Program Interfaces (APIs) are available to directly        access system and patient data without needing to use messaging        encoding and decoding processes. This mechanism is particularly        useful for viewers that need to collect data from multiple        system and then integrate the display of a unified patient        record.        Conclusions and Interpretation

It will be appreciated that the disclosure above provides varioussignificant frameworks and methodologies configured to enable design andimplementation of customised clinical information systems

Unless specifically stated otherwise, as apparent from the followingdiscussions, it is appreciated that throughout the specificationdiscussions utilizing terms such as “processing,” “computing,”“calculating,” “determining”, analyzing” or the like, refer to theaction and/or processes of a computer or computing system, or similarelectronic computing device, that manipulate and/or transform datarepresented as physical, such as electronic, quantities into other datasimilarly represented as physical quantities.

In a similar manner, the term “processor” may refer to any device orportion of a device that processes electronic data, e.g., from registersand/or memory to transform that electronic data into other electronicdata that, e.g., may be stored in registers and/or memory. A “computer”or a “computing machine” or a “computing platform” may include one ormore processors.

The methodologies described herein are, in one embodiment, performableby one or more processors that accept computer-readable (also calledmachine-readable) code containing a set of instructions that whenexecuted by one or more of the processors carry out at least one of themethods described herein. Any processor capable of executing a set ofinstructions (sequential or otherwise) that specify actions to be takenare included. Thus, one example is a typical processing system thatincludes one or more processors. Each processor may include one or moreof a CPU, a graphics processing unit, and a programmable DSP unit. Theprocessing system further may include a memory subsystem including mainRAM and/or a static RAM, and/or ROM. A bus subsystem may be included forcommunicating between the components. The processing system further maybe a distributed processing system with processors coupled by a network.If the processing system requires a display, such a display may beincluded, e.g., a liquid crystal display (LCD) or a cathode ray tube(CRT) display. If manual data entry is required, the processing systemalso includes an input device such as one or more of an alphanumericinput unit such as a keyboard, a pointing control device such as amouse, and so forth. The term memory unit as used herein, if clear fromthe context and unless explicitly stated otherwise, also encompasses astorage system such as a disk drive unit. The processing system in someconfigurations may include a sound output device, and a networkinterface device. The memory subsystem thus includes a computer-readablecarrier medium that carries computer-readable code (e.g., software)including a set of instructions to cause performing, when executed byone or more processors, one of more of the methods described herein.Note that when the method includes several elements, e.g., severalsteps, no ordering of such elements is implied, unless specificallystated. The software may reside in the hard disk, or may also reside,completely or at least partially, within the RAM and/or within theprocessor during execution thereof by the computer system. Thus, thememory and the processor also constitute computer-readable carriermedium carrying computer-readable code.

Furthermore, a computer-readable carrier medium may form, or be includedin a computer program product.

In alternative embodiments, the one or more processors operate as astandalone device or may be connected, e.g., networked to otherprocessor(s), in a networked deployment, the one or more processors mayoperate in the capacity of a server or a user machine in server-usernetwork environment, or as a peer machine in a peer-to-peer ordistributed network environment. The one or more processors may form apersonal computer (PC), a tablet PC, a set-top box (STB), a PersonalDigital Assistant (PDA), a cellular telephone, a web appliance, anetwork router, switch or bridge, or any machine capable of executing aset of instructions (sequential or otherwise) that specify actions to betaken by that machine.

Note that while diagrams only show a single processor and a singlememory that carries the computer-readable code, those in the art willunderstand that many of the components described above are included, butnot explicitly shown or described in order not to obscure the inventiveaspect. For example, while only a single machine is illustrated, theterm “machine” shall also be taken to include any collection of machinesthat individually or jointly execute a set (or multiple sets) ofinstructions to perform any one or more of the methodologies discussedherein.

Thus, one embodiment of each of the methods described herein is in theform of a computer-readable carrier medium carrying a set ofinstructions, e.g., a computer program that is for execution on one ormore processors, e.g., one or more processors that are part of webserver arrangement. Thus, as will be appreciated by those skilled in theart, embodiments of the present invention may be embodied as a method,an apparatus such as a special purpose apparatus, an apparatus such as adata processing system, or a computer-readable carrier medium, e.g., acomputer program product. The computer-readable carrier medium carriescomputer readable code including a set of instructions that whenexecuted on one or more processors cause the processor or processors toimplement a method. Accordingly, aspects of the present invention maytake the form of a method, an entirely hardware embodiment, an entirelysoftware embodiment or an embodiment combining software and hardwareaspects. Furthermore, the present invention may take the form of carriermedium (e.g., a computer program product on a computer-readable storagemedium) carrying computer-readable program code embodied in the medium.

The software may further be transmitted or received over a network via anetwork interface device. While the carrier medium is shown in anexemplary embodiment to be a single medium, the term “carrier medium”should be taken to include a single medium or multiple media (e.g., acentralized or distributed database, and/or associated caches andservers) that store the one or more sets of instructions. The term“carrier medium” shall also be taken to include any medium that iscapable of storing, encoding or carrying a set of instructions forexecution by one or more of the processors and that cause the one ormore processors to perform any one or more of the methodologies of thepresent invention. A carrier medium may take many forms, including butnot limited to, non-volatile media, volatile media, and transmissionmedia. Non-volatile media includes, for example, optical, magneticdisks, and magneto-optical disks. Volatile media includes dynamicmemory, such as main memory. Transmission media includes coaxial cables,copper wire and fiber optics, including the wires that comprise a bussubsystem. Transmission media also may also take the form of acoustic orlight waves, such as those generated during radio wave and infrared datacommunications. For example, the term “carrier medium” shall accordinglybe taken to included, but not be limited to, solid-state memories, acomputer product embodied in optical and magnetic media; a mediumbearing a propagated signal detectable by at least one processor of oneor more processors and representing a set of instructions that, whenexecuted, implement a method; and a transmission medium in a networkbearing a propagated signal detectable by at least one processor of theone or more processors and representing the set of instructions.

It will be understood that the steps of methods discussed are performedin one embodiment by an appropriate processor (or processors) of aprocessing (i.e., computer) system executing instructions(computer-readable code) stored in storage. It will also be understoodthat the invention is not limited to any particular implementation orprogramming technique and that the invention may be implemented usingany appropriate techniques for implementing the functionality describedherein. The invention is not limited to any particular programminglanguage or operating system.

It should be appreciated that in the above description of exemplaryembodiments of the invention, various features of the invention aresometimes grouped together in a single embodiment, FIG. or descriptionthereof for the purpose of streamlining the disclosure and aiding in theunderstanding of one or more of the various inventive aspects. Thismethod of disclosure, however, is not to be interpreted as reflecting anintention that the claimed invention requires more features than areexpressly recited in each claim. Rather, as the following claimsreflect, inventive aspects lie in less than all features of a singleforegoing disclosed embodiment. Thus, the claims following the DetailedDescription are hereby expressly incorporated into this DetailedDescription, with each claim standing on its own as a separateembodiment of this invention.

Furthermore, while some embodiments described herein include some butnot other features included in other embodiments, combinations offeatures of different embodiments are meant to be within the scope ofthe invention, and form different embodiments, as would be understood bythose skilled in the art. For example, in the following claims, any ofthe claimed embodiments can be used in any combination.

Furthermore, some of the embodiments are described herein as a method orcombination of elements of a method that can be implemented by aprocessor of a computer system or by other means of carrying out thefunction. Thus, a processor with the necessary instructions for carryingout such a method or element of a method forms a means for carrying outthe method or element of a method. Furthermore, an element describedherein of an apparatus embodiment is an example of a means for carryingout the function performed by the element for the purpose of carryingout the invention.

In the description provided herein, numerous specific details are setforth. However, it is understood that embodiments of the invention maybe practiced without these specific details. In other instances,well-known methods, structures and techniques have not been shown indetail in order not to obscure an understanding of this description.

Similarly, it is to be noticed that the term coupled, when used in theclaims, should not be interpreted as being limited to direct connectionsonly. The terms “coupled” and “connected,” along with their derivatives,may be used. It should be understood that these terms are not intendedas synonyms for each other. Thus, the scope of the expression a device Acoupled to a device B should not be limited to devices or systemswherein an output of device A is directly connected to an input ofdevice B. It means that there exists a path between an output of A andan input of B which may be a path including other devices or means.“Coupled” may mean that two or more elements are either in directphysical or electrical contact, or that two or more elements are not indirect contact with each other but yet still co-operate or interact witheach other.

Thus, while there has been described what are believed to be thepreferred embodiments of the invention, those skilled in the art willrecognize that other and further modifications may be made theretowithout departing from the spirit of the invention, and it is intendedto claim all such changes and modifications as falling within the scopeof the invention. For example, any formulas given above are merelyrepresentative of procedures that may be used. Functionality may beadded or deleted from the block diagrams and operations may beinterchanged among functional blocks. Steps may be added or deleted tomethods described within the scope of the present invention.

The invention claimed is:
 1. A computer implemented method for providingClinical Information System (CIS) functionalities, comprising: providinga plurality of purpose-specific CIS interfaces, wherein each interfaceis renderable at a given client terminal based on CIS interface designdata, wherein the CIS interface design data includes: (i) content pages,wherein each content page is configured to contain one or more pageobjects; and (ii) logical rules defining navigation and behaviour of thecontent pages; wherein each of the plurality of purpose-specific CISinterfaces is configured to retrieve and input patient information to acommon central patient information database; wherein each of theplurality of purpose-specific CIS interfaces has direct native access tofunctionalities of a common Patient Administration System (PAS);displaying, via the client terminal, a plurality of page objects;receiving, via a graphical interface, a selection of a page object ofthe plurality of page objects; in response to receiving the selection ofthe page object, opening an object parameter setting interface of thepage object; receiving, via the graphical interface, a selection of anobject parameter; associating the selected object parameter with apre-defined formal value; identifying, via a processor, apurpose-specific CIS interface of the plurality of purpose-specific CISinterfaces associated with the formal value; and in response toreceiving the formal value, generating via a processor a custom CIS userinterface.
 2. The framework according to claim 1, wherein the pluralityof page objects is expandable by administrator definition of one or morenew or modified customisable objects.
 3. The framework according toclaim 1, wherein the one or more page objects are customisable pageobjects, and wherein the page objects include: information objects,interactive buttons, input fields, and data fields.
 4. The methodaccording to claim 1, wherein the pre-defined formal value is defined inan independent formal ontology.
 5. The method according to claim 1,wherein the page objects include at least one of a data object and/or aprocess object.
 6. A system for delivering a computer implementedframework for providing Clinical Information System (CIS)functionalities, the framework including: a plurality ofpurpose-specific CIS interfaces, wherein each interface is renderable ata given client terminal based on CIS interface design language, whereinthe CIS interface design language includes: (i) content pages, whereineach content page is configured to contain one or more page objects; and(ii) logical rules defining navigation and behaviour of the contentpages; and a common central patient information database, wherein theplurality of purpose specific CIS interfaces each have direct read andwrite access of the common central patient information database, whereinthe system comprises: a CIS management system on one or more serverscomprising: a content and process design user interface configured withinstructions stored in a non-transitory memory to define content andprocess data for enabling creation of the plurality of purpose-specificCIS interfaces; a content and process data repository configured withinstructions stored in the non-transitory memory for rendering theplurality of purpose-specific CIS interfaces; and a content and processengine configured with instructions stored in the non-transitory memoryto generate CIS data, the CIS data being indicative of user-generatedcontent pages and comprising the logical rules defining navigation andbehaviour of the content pages, wherein the user-generated content pagesare based on a user selection of page objects configured to referencevalues in a patient data repository; and an external interaction modulecommunicatively coupled to the CIS management system and configured toenable interaction of the CIS management system with externalapplications.
 7. The framework according to claim 6, including thecontent and process design user interface that provides design userswith a graphical editor interface thereby to define and/or modify one ormore of the plurality of purpose-specific CIS interfaces.
 8. Theframework according to claim 7, wherein the content and process designuser interface enables a design user to select a customisation pageobject from a set of available objects, and customise that object bysetting one or more parameters.
 9. The framework according to claim 8,wherein the set of available objects is expandable by administratordefinition of one or more new or modified customisable objects.
 10. Theframework according to claim 6, wherein the one or more page objects arecustomisable page objects defined and/or modified via the content andprocess design user interface, wherein the page objects include:information objects, interactive buttons, input fields, and data fields.11. A computer implemented method for providing Clinical InformationSystem (CIS) functionalities, the method including: providing a contentand process design user interface, thereby to enable a design user todefine, by way of a graphical Interface, CIS interface design data,wherein the CIS interface design data includes content pages, whereineach content page is configured to contain one or more customisable pageobjects; displaying, via a client terminal, a content page comprisingthe one or more customisable page objects; receiving, via a graphicalinterface, a selection of a page object of the one or more customisablepage objects; in response to receiving the selection of the page object,opening an object parameter setting interface of the page object;receiving, via a graphical interface, a selection of an objectparameter; associating the selected object parameter with a pre-definedformal value; identifying a CIS interface of a plurality of CISinterfaces associated with the pre-defined formal value; and in responseto receiving the pre-defined formal value, generating a custom CIS userinterface at distributed clinician client terminals, wherein each customCIS user interface has direct read and write access to a common set ofpatient management systems and databases.
 12. The method according toclaim 11, wherein a set of available page objects is expandable byadministrator definition of one or more new or modified customisablepage objects.
 13. The method according to claim 11, wherein the one ormore customisable page objects include: information objects, interactivebuttons, input fields, and data fields.
 14. The method according toclaim 11, wherein the common set of patient management systems anddatabases includes a common patient registration and management system.15. The method according to claim 11 wherein defining, by way of thegraphical interface, includes customising a given page object to obtaina data value inputted by a specified further page object.
 16. The methodaccording to claim 15, wherein the specified further page object isdefined on a page other than the content page currently being edited.17. The method according to claim 15, wherein the specified further pageobject is defined on a page belonging to a CIS system other than the CISsystem which contains the content page currently being edited.
 18. Themethod according to claim 11, wherein the common set of patientmanagement systems and databases includes a common patient database.